Background
Little is known about what happens when patients and caregivers are involved in an academic setting as co-teachers and how healthcare professionals approach a new model of partnership-based teaching. This study aimed to explore the learning and behavioural patterns of a group of healthcare professionals who were learning to teach with patients and caregivers as co-teachers in a post-graduate course.
Methods
A focused ethnographic study involving 11 health professionals was conducted. Data were collected through participatory observation during the course, individual semi-structured interviews, and a follow-up focus group. Taxonomic analysis was performed.
Results
Three categories were identified: ‘group’, ‘role of narration’ and ‘applying co-teaching with patients and caregivers ’. Specifically, heterogeneity, absence of hierarchies, and balanced relationships characterised the group dynamic and promoted partnership. Narration played a key role both in learning and in healthcare professionals’ relationship with patients and caregivers and promoted emotional skills and self-awareness. Project planning and lessons simulations were essential aspects of the implementation process.
Conclusions
This focused ethnography helped further understanding of the context of a specific project involving patients and caregivers as co-teachers in healthcare professional education. The development of emotional skills and self-awareness are the main learning patterns of co-teaching, and interprofessionalism and balanced relationships are the basis of the behavioural patterns. These patterns facilitated the involvement of patients and caregivers in health education.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-024-05197-5.
Keywords: Healthcare professional education, Patient and caregiver participation, Narration, Emotions, Interprofessional relations, Qualitative research
Background
Recent years have seen a growing interest in involving patients and caregivers in the education process of healthcare professionals. This involvement is associated with promoting the relational mechanisms that foster patient-centred outcomes [1, 2]. The heterogeneity of educational activities that involve patients and caregivers has been a common focus of several reviews, which have demonstrated that patient and caregivers’ involvement is a complex educational intervention occurring in a social environment containing many stakeholders [3–9]. Patients involved are individuals with significant experience of illness or healthcare, and caregivers are carers who regularly provide care for a child, or a sick, elderly, or disabled person. Both groups utilize the skills acquired from their experiences and specific training to offer an integrated perspective in education and carry out educational interventions. They are involved in educational programs that focus on specific clinical condition such as mental health, chronic care, older adult care, paediatric care, disability and cancer, as well as organizational, communication and relational aspects of care [2, 8]. A recent review has described the multifaceted components of this educational intervention and concluded that more work is required to identify the mechanism through which patient involvement enhances learning and to explore what involvement within the education community means for both faculty and patients [10]. Furthermore, the effects on staff and patients as well as students have to be considered when evaluating educational programs that involve patients [11]. Patient and caregivers’ involvement in education has been associated with increased understanding of the importance of patient-centredness and communication, building and improving skills that help patients make informed decisions, and exhibiting appropriate professional behaviours and relationships demonstrating respect and compassion [7]. A randomised controlled trial showed that an educational intervention co-conducted by two patients (a 70- year-old woman with amyloidosis and a 40-year-old woman with previous breast cancer) and nursing teachers compared to an intervention conducted by the nursing teachers alone was more effective in increasing empathy levels in nursing students [12].
However, little is known about what happens when patients and caregivers enter an academic setting as teachers. Involving patients in education means changing the traditional educational paradigm, in which only healthcare professionals act as teachers, versus an alternative based on partnership between healthcare professionals and patients as respective experts in disciplinary and experiential knowledge. The latter can be complicated to implement; nevertheless, few studies have examined how the role of teachers and context change. In their review, de Groot et al. found two prominent teacher roles in educational interventions that involved patients: carer and assessor [1]. The first role implies that the teacher is not primarily the ‘expert who will give all the answers’ but rather someone who cares for learners and recognises that interactions with severely ill people for the first time might be challenging. In contrast to this role, wherein teachers feel their primary responsibility is to support learners, is that of assessor, in which the teacher evaluates whether students have made sufficient progress and are ‘good enough’.
Moreover, some studies have found negative attitudes from healthcare-professional teachers toward patient involvement in education; for example, patients’ views can sometimes conflict with those of healthcare professionals, causing the latter to worry their own expertise could be devalued [13]. In most studies patients and caregivers are involved together and differences in results are not presented, however a qualitative study, which presents the perspective of two caregivers involved in education and the perspective of academics, reports how the latter were worried about what they perceived as a possible shift in the balance of power. Their chief concern was who would have the final say on which students should be offered a place if they disagreed with carers. Despite their initial doubts and reservations, once the academics had a chance to work with them they reflected on the experience positively [14]. A recent ethnographic study reported that transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among healthcare professionals [15]. When called to work with patients or caregivers outside of a simple therapeutic relationship, healthcare professionals may feel tension between their identities as caregivers and as colleagues. Identity tensions included competing ideals of the ‘good professional’, challenges to the permeability of the ‘patient’ and ‘professional’ categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.
As a complex intervention, implementing patient involvement in Healthcare Professionals Education (HPE) requires an understanding of the context in which the practice is to be used. For example, how teachers work together, leadership and organisational support for new practices, school culture, faculty resources, and other factors can influence implementation. Further, what works in one setting and course and with one group of students may not work in another. Implementation studies can be used to explore these factors; they take place in real-world settings, so researchers’ task is to identify potentially relevant variables that might influence the outcomes and to incorporate these into the study, often as research questions. Examples of these variables are teachers’ shared beliefs, learning patterns, and behaviours [16].
Aim and research question
This study is part of a research project whose overall objective is to implement patients’ and caregivers’ involvement in HPE as a complex educational intervention. Accordingly, this study aimed to describe the experiences of healthcare professionals participating in a post-graduate teaching course that included patients and caregivers as co-teachers. The following research question was set: What are the shared beliefs and learning and behaviour patterns of healthcare professionals in a post-graduate course regarding patients’ and caregivers’ involvement in HPE?